Strong Insurance Background
Resume:
Alvin Douglas
East Hartford, CT 06108
**************@*****.***
OBJECTIVE
To use my background and experience to represent my employer in a positive and productive manner
PROFESSIONAL EXPERIENCE
Aetna. Hartford, CT 2007 – Present
Senior Underwriting Analyst (2009 – Present)
- Review of plan documents and amendments in order to assess potential liability for the medical stoploss market
- Procurring vital information which is needed in order to have sold policies issued
- Provides underwriting support for new business quotes, renewals, accountings and/or specialized functions
- Produces timely and accurate quotes, renewals, and/or accountings
- Performs more complex analysis. Analyzes input/outputs for reasonability (e.g., manual rates,
- benefit revisions, recorded claims, premiums, reserves, ECS charges, account structure, etc.)
- Performs risk assessment functions as directed (e.g., claim determination and membership analysis) to set appropriate premium
- Applies underwriting guidelines in qualifying risk of adding new members Requests and provides additional information as necessary and explains needs
- Maintains integrity of source data and/or accounting data systems
- Trains, mentors and/or assists others in preparing quotes, renewals and/or accountings. May review the work of others
- Shares system expertise with team members and/or other internal constituents
Underwriting Analyst (2007 – 2009)
- Provides underwriting support for intake of new business quotes and renewals.
- Screens quote submissions by applying basic underwriting guidelines and principles to determine viability of quote.
- Analyzes input/outputs for reasonability (e.g., manual rates, benefit revisions, census rating, etc.)
- Provides prompt turn around in case review.
- Establishes and maintains professional communications with internal an external parties.
- Provides administrative support for Underwriting and Case Management functions including but not limited to filing, data entry, etc.
- Requests additional information as necessary and explains needs .
- Maintains integrity of source data and/or data systems as well as physical file maintenance.
- Identifies and collects information critical to decision making.
ConnectiCare, Farmington, CT 2005 – 2007
Pharmacy Customer Service Associate (2006-2007)
- Received and responded to telephone calls and correspondence from members, providers and facilities regarding pharmacy related inquires.
- Adhered to established guidelines and standards for customer service excellence. Acted as customers advocate in providing assistance to resolve callers’ issues and problems and educate callers regarding pharmacy benefits.
- Maintained telephone log documenting number, content and type of call for every call received
- Explained pharmacy pre-authorization requirements and disposition of pre-authorized requests, as necessary
- Collaborated with Medical Operations and Medical Quality to identify issues or areas of concern for providers specifically related to pharmacy inquires.
- Maintained comprehensive knowledge of CCI Rx rider information, pharmacy related systems, and administrations of Pharmacy benefits.
- Researched and analyzed recurring provider, hospital and member problems/complaints to determine root causes and trends; recommended solutions and/ or resolutions.
Customer Service Associate (2005-2006)
- Review of plan documents in order to give members and providers and accurate depiction of what is and is not covered by their plan
- Received and responded to telephone calls and correspondence from members, providers and facilities regarding pharmacy related inquires.
- Collaborated with Medical Operations and Medical Quality to identify issues or areas of concern for providers specifically related to pharmacy inquires
- Collaborated with Account management, Product Management, Marketing and Sales teams to identify areas of member/participant dissatisfaction and trends concerning membership or benefits.
- Investigated requests for claims adjustments by callers and collaborated with Claims teams to ensure claims adjustments have been made. Followed through with callers.
OTHER RELATED EXPERIENCE
- Ticket Network Direct, Vernon, CT, Customer Service Representative
- Radioshack, Vernon, CT, Stock Associate
- Greater Hartford Legal Aid Inc, Hartford, CT, Intern
- Aids Legal Network, Hartford, CT, Intern
- Kelly’s Services, Farmington, CT, Substitute Teacher
EDUCATION
Bachelor’s Degree- University of Connecticut
Major-History
Storrs, CT
TECHNICAL SKILLS
Microsoft Windows, Microsoft Word, Excel, PowerPoint, Outlook,
Amysis Systems
Service Matrix Systems
AWARDS
Royal Treatment Customer Service Representative of the year- Connecticare
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